ECG: Atrial Infarct

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ECG: Atrial Infarct

  1. 1. PHYSICIANS MEET PROF.DR.DHANDAPANI’S UNIT AN INTERESTING ECG DR D SUBBURAJ
  2. 2. <ul><li>65/M presented with substernal chest discomfort , lasted for 15 mins </li></ul><ul><li>Not radiating </li></ul><ul><li>Ass. With nausea & diaphoresis </li></ul><ul><li>No h/o DM or SHT </li></ul><ul><li>o/e - diaphoretic, BP- 90/60mmHg, PR-54bpm </li></ul><ul><li>CVS- S1 S2 +, No murmur RS - NVBS + , Other systems- normal </li></ul>
  3. 4. LIMB LEADS
  4. 5. Chest leads v1
  5. 6. ECG FINDINGS <ul><li>Sinus rhythm </li></ul><ul><li>Rate-54 </li></ul><ul><li>PR-252ms </li></ul><ul><li>Cardiac axis 2 degrees </li></ul><ul><li>QTc-399 ms </li></ul><ul><li>ST elevation II,III,a VF,V5,V6. depression I,a VL,V2,V3 </li></ul><ul><li>P Ta elevation II,III,a VF,V5 ,V6, depression in V1,V2 </li></ul>
  6. 7. <ul><li>Pta SEGMENT ELEVATED IN II,III , aVF. </li></ul>
  7. 8. <ul><li>CHEST LEADS </li></ul>
  8. 9. <ul><li>ATRIAL INFARCT WITH INFERO POST LATERAL WALL INFARCT & FIRST DEGREE HEART BLOCK </li></ul>
  9. 10. ATRIAL INFARCTION <ul><li>Seen in upto 10% of patients with STEMI. </li></ul><ul><li>Rt atrial 81-98% </li></ul><ul><li>Biatrial 19-24% </li></ul><ul><li>Lt atrial 2-19% </li></ul><ul><li>Often clinically unrecognized because of its subtle ECG changes. </li></ul>
  10. 11. DIAGNOSIS <ul><li>The diagnosis of atrial infarction is usually made from elevation of P-Ta segment in the clinical setting of MI. </li></ul><ul><li>The diagnosis may be entertained when the P-Ta segment is minimally elevated, i.e. in the same direction as the p wave. (Schamroth) </li></ul>
  11. 12. P-Ta segment <ul><li>From end of P wave to beginning of QRS </li></ul>
  12. 13. DIAGNOSTIC CRITERIA <ul><li>1. PTa segment elevation >0.5 mm in leads v5,v6 with reciprocal PTa segment depression in leads v1,v2. </li></ul><ul><li>2. PTa segment elevation >0.5 mm in lead I with reciprocal PTa segment depression in leads II,III </li></ul>
  13. 14. <ul><li>PTa segment depression >1.5 mm in precordial leads . </li></ul><ul><li>PTa segment depression >1.2 mm inleads I,II,III and in associaton with any atrial arrhythmias. </li></ul><ul><li>5 Abnormal p wave: flattening of p wave in M pattern, flattening of p wave in W pattern, </li></ul><ul><li>irregular or notched p wave according to lieu et al </li></ul>
  14. 15. COMPLICATIONS <ul><li>Arrhythmias :61-74% </li></ul><ul><li>AF, SVT, atrial premature beats </li></ul><ul><li>Thromboembolism: 84 % </li></ul><ul><li>systemic, pulmonary </li></ul><ul><li>Atrial rupture :4-5% </li></ul><ul><li>Hemodynamic disturbances </li></ul>
  15. 16. RCA <ul><li>RCA SUPPLIES SA node,AV node, RV , posteromedial papillary muscle ,inf part of LV, variabily post&lat segments of LV. </li></ul><ul><li>RV BRANCH –from proximal seg of RCA </li></ul><ul><li>RCA OCCLUSION- </li></ul><ul><li>SA NODE- sinus bradycardia </li></ul><ul><li>AVNODE-AV nodal block </li></ul><ul><li>RV-Cardiogenic shock </li></ul><ul><li>PAPILLARY MUSCLE-MR </li></ul><ul><li>INFERO POST LATERAL MI </li></ul>
  16. 17. RCA OR CX ? <ul><li>RCA </li></ul><ul><li>ST elevation III>II </li></ul><ul><li>ST depression aVL> I </li></ul><ul><li>ST dep in I </li></ul><ul><li>CX </li></ul><ul><li>ST elevation in II>III </li></ul><ul><li>ST isoelectric LEAD I </li></ul>avL aVR III II
  17. 18. PROXY OR DISTAL <ul><li>RV branch is from proxymal seg </li></ul><ul><li>PROXYMAL OCCULSION- ST ELEVATION & POSITIVE T in V 4R, </li></ul><ul><li>DISTAL- ISOELECTRIC ST,POSITIVE T. </li></ul><ul><li>NEGATIVE T- CX OCCULSION </li></ul><ul><li>ATRIAL INFARCT – PROXYMAL OCCLUSION </li></ul>
  18. 19. <ul><li>ANOTHER ECG OF RCA OCCLUSION </li></ul>I II III aVF aVL aVR V1 V2 V3 V4 V5 V6
  19. 20. <ul><li>REF : HURST 11 th edition </li></ul><ul><li>SCHAMROTH </li></ul><ul><li>THANK YOU </li></ul>

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